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THE RENAL TRACT 171
Table 7.2 Differential diagnoses for fluid-filled
renal masses
RK
s
Solitary lesions
Complex fluid lesions
Pelvicalyceal system
dilatation
Multiple cystic lesions
Simple cyst
Infected or haemorrhagic cyst
Hydatid cyst (rare)
Haematoma
Abscess
Lymphoma
Necrotic primary or secondary
tumour
Tuberculosis
Obstructive or non-obstructive
causes
Xanthogranulomatous
pyelonephritis
Polycystic or acquired cystic
disease
Multiple abscesses
A
do not shadow on ultrasound, are associated with
conditions such as tuberculosis, xanthogranulomatous
pyelonephritis, nephrocalcinosis or some neoplastic
tumours.
Renal tract stones
Renal calculi are a common finding on ultrasound.
They may be an incidental discovery in an asymptomatic
patient; alternatively they may be present in
patients with acute renal colic and complete or partial
obstruction of the ipsilateral renal tract. They
may be the cause of haematuria and can also be associated
with urinary tract infections. The composition
of calculi can vary. The common types include:
●
●
●
●
Calcium stones are the most common type and
are frequently associated with patients who
have abnormal calcium metabolism.
Struvite (triple phosphate) stones have a different
composition of salts and are associated with
urinary tract infections. They may form large,
staghorn calculi (see below).
Uric acid stones are rare, and tend to be
associated with gout.
Cystine stones are the rarest of all and result from
a disorder of amino acid metabolism—
cystinuria.
B
Figure 7.15 (A) Papillary necrosis. The calyces are
mildly dilated with blunted, irregular margins and
contain low-level echoes from sloughed papillae.
(B) IVU of the same patient demonstrating the
blunted calyces.